Chronic type B dissections: are fenestrated and branched endografts an option?

Area of Science:

• Vascular Surgery
• Endovascular Interventions
• Aortic Aneurysm Disease

Background:

• Thoracoabdominal aortic aneurysms (TAAAAs) pose significant treatment challenges.
• Chronic dissections represent a complex etiological subgroup of TAAAs.
• Existing endovascular repair outcomes for TAAAs are encouraging but less established for dissections.

Purpose of the Study:

• To review and present endovascular options for treating thoracoabdominal aortic aneurysms secondary to chronic dissections.
• To highlight the specific technical challenges encountered in these complex cases.
• To provide a comprehensive overview of current endovascular strategies.

Main Methods:

• Review of available endovascular techniques for TAAA repair in chronic dissections.
• Discussion of challenges related to proximal sealing zone, narrow aortic lumen, and target vessel perfusion.
• Analysis of strategies to maintain perfusion to visceral and supra-aortic vessels, including those from the false lumen.

Main Results:

• Endovascular repair of TAAAs with chronic dissections presents unique technical difficulties.
• Management of the proximal sealing zone is a critical aspect.
• Maintaining perfusion to all essential vessels, regardless of their origin (true or false lumen), is paramount.

Conclusions:

• Chronic dissections are a challenging subgroup of thoracoabdominal aortic aneurysms.
• Various endovascular options exist, but careful consideration of technical challenges is necessary.
• Successful treatment requires meticulous planning and execution to ensure adequate perfusion and sealing.